Provider Demographics
NPI:1851606297
Name:POTRA, ELENA N/A (PHDFC)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:N/A
Last Name:POTRA
Suffix:
Gender:F
Credentials:PHDFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 NW 18TH ST APT 202
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-6866
Mailing Address - Country:US
Mailing Address - Phone:954-701-5701
Mailing Address - Fax:
Practice Address - Street 1:3500 N STATE ROAD 7 STE 211
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5625
Practice Address - Country:US
Practice Address - Phone:954-578-8399
Practice Address - Fax:954-578-0145
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist